The Independent Review of NHS Dental Services in England: summary

Provide a clear patient pathway

The report recommends that NHS dentistry should be organised along a pathway of care with clear signposting for both patients and dentists.

According to this new model of care:

• everyone should be entitled to urgent care when required
• people without a regular dentist should be given the opportunity to access continuing care
• new patients should be given an oral health assessment, and existing patients should have their preventive needs managed.

Advanced care (eg, root canal treatment) should be consistent with evidence-based guidelines and best practice and should be provided only when the patient is in a continuing care relationship with a dentist and where there is a ‘stable and low risk oral environment’, ie, where the patient is able and willing to look after their teeth afterwards. The review team recommends that oral health be ‘firmly’ embedded in public health initiatives and supports the extension of water fluoridation.

Pilot a new contract

The review proposes that the new contract, which blends payments for activity, care quality and providing continuing care to registered patients, should be piloted by the Department of Health access unit when procuring new dental practices in areas where capacity is low.

This contract would comprise three elements:

• ‘continuing care’: dentists would receive per capita payments adjusted to take account of the demographics of the population of their practice. They would be responsible for preventive care, urgent care and for providing convenient opening hours
• activity: currently dentists are funded on the basis of performing an agreed number of units of dental activity (UDAs) which fall into three ‘bands’. Under the review team’s proposals, payments for activity would be refined so that, for example, a small filling would receive a lower fee than several large ones. There would also be payments for preventive activities such as advice on hygiene. It is possible that payment for activity might make up less than half of the total remuneration under the new contract
• quality: dentists would receive payments for compliance with a nationally determined set of quality measures. These would be based on clinical guidelines developed by NICE (see below for details), for example, on rates of antibiotic prescription.

The review also proposes that the contract includes a requirement that dentists rectify any treatment carried out by them that goes wrong within three years, which in effect constitutes a warranty, and recommends that this be introduced within 18 months.

Improve commissioning

PCTs have had responsibility for commissioning dental care since 2006. The report comments that commissioning of dentistry has often been left to junior staff, and that commissioners have not made use of flexibilities in the existing contract. It recommends that:

• dentistry should be explicitly included in the world class commissioning assurance process
• PCTs should consider joint commissioning of advanced services to make best use of what expertise there is
• dentists should be included in Professional Executive Committees (PECs)
• PCTs should consider how they can fully involve consultants in dental public health (once a separate review currently being carried out by the Department of Health has been published).

Quality

The review identifies a number of prerequisites that must be met before the proposed quality element of the contract can be put into operation:

• the Department of Health needs to develop a set of national quality outcomes based on the patient pathway
• new standards and guidelines should be developed through the Quality Standards Programme being set up by NICE, which will bring together existing information and guidance on good clinical practice. These will inform the quality outcome measures
• by 2011 all dentists should have the capacity to submit data electronically ‘from chair-side to NHS Business Services Authorities and PCTs’. Currently only 70 per cent of providers submit data by electronic means.

It is recommended that PCTs should audit all premises to ensure that they meet ‘patient expectations’. The report suggests that the Primary Care Contracting Group could develop a national template to be used in this process. 

Patient information and patient charges

The report recommends increasing the availability of information for patients, for example, through NHS Choices, including:

• information on how to access NHS dental services
• data generated as part of the assessment of the quality element of the contract
• information on patient charges.

The review recommends a further review of patient charges (which provide 29 per cent of dentists’ income) to be carried out after the new contracts have been piloted. Any revisions must ensure that charges are simple, fair and incentivise good self-care. There are currently three bands of charges, which the report says can result in patients paying the same fee while receiving varying amounts of care. The number of bands should be increased but should not exceed ten.

Changes to funding allocations

Funding currently reflects historical activity levels. The review team recommends that allocations from the Department of Health to PCTs should be made on a per capita basis adjusted for need under a process similar to that used in the annual PCT allocation formula.

Implementation

The review sets out a three-year timescale for the delivery of their recommendations.

The government has accepted these recommendations in principle subject to working through the detail of their financial implications.